New bill would protect patients from surprise medical bills

Washington patients could soon be protected from surprising and at times expensive medical bills caused by a practice known as balance billing.

Author:
Danielle Leigh

Published:
9:39 PM PST January 18, 2017

Washington patients could soon be protected from surprising and at times expensive medical bills caused by a practice known as balance billing.

In Olympia, the House Health Care and Wellness Committee held a hearing Wednesday on a bi-partisan proposal to prohibit insurers and providers from balance billing in the case of emergencies or when patients visit in-network facilities.

Balance billing happens when patients are charged the difference between what an insurance company is willing to pay and what a doctor or provider wants to make.

"I think when you are paying your insurance premium and you think you are covered, you shouldn't end up getting a bill," said sponsor Rep. Eileen Cody, D-Seattle. "There is interest from all sides to get this worked out this year, and that is good for the consumers."

HB1117 also establishes an arbitration process for doctors, insurers, and providers to resolve disputes about prices without putting patients in the middle.

Patients such as Jeff Keenan, who has experienced a surprising bill, testified before the Committee that the proposal is a positive and necessary step forward.

"You can do all the due diligence in the world about whether the first door you walk through is covered, but after you walk through that first door, there are all these other doors," said Keenan. "And I had no clue that I would be charged or that it would be out-of-network. You really are blind."

The Washington Insurance Commissioner conducted a data call with insurers last year and found that in 2015, 294,000 claims out of 1.7 million were surprise bills. In other words, surprise billing had played a role in about 17 percent of total insurance claims.

Doctors, insurers, and providers all expressed concerns about certain elements of the proposed legislation and how it would impact their ability to do business during the hearing Wednesday.

Each expressed concerns the legislation could give one party an unfair advantage over another.

"99.7 percent of the time, the two sides do get along, and we do compromise," said Dr. Nathan Schlicher, secretary-treasurer of the Washington State Medical Association. "That is an overwhelming success rate of us getting along, and the problem is politics have gotten involved here, and we have to solve a small problem with a bazooka."

This new bill follows a failed attempt in 2016 to pass new legislation to end balance billing.

Despite the resistance from industry insiders, Cody expressed confidence the bill would ultimately pass this year.

HB1117 must be approved by the House and Senate before it can reach the governor's desk.